Prognosis of haemorrhagic stroke in childhood: a long-term follow-up study

Abstract

Little is known about long-term physical sequelae, cognitive functioning, and quality of life of children who have had a haemorrhagic stroke. Fifty-six patients (29 females, 27 males) under 16 years of age at time of the bleeding were studied. Mean age at time of bleeding was 7.7 years (range 1 month to 15.9 years). The primary site and cause of the bleeding at baseline were determined. Occurrences of death, re-bleedings, and seizures during follow-up were recorded. Patients who survived were invited for a follow-up examination including physical check-up, general screening of cognition, and an inventory of subjective health perception. Thirteen children died directly as a result of the haemorrhage; nine experienced a recurrent bleeding, which was fatal in three; six children developed epileptic seizures. At follow-up 36 of 56 patients were still alive. Mean follow-up time was 10.3 years (range 1.3 to 19.9 years) and mean age was 18.6 years (range 1.8 to 34.1 years). There was no patient lost to follow-up. Five patients declined to visit the hospital. In 15 out of 31 patients who could be examined, no physical impairment was observed, 11 had a hemiparesis of varying severity, and three had symptoms of cerebellar ataxia. One child had persisting tetraparesis and one persisting paraparesis. Signs of cognitive deficits were found in 15 patients. Of the children who survive haemorrhagic stroke, the physical and functional prognosis is relatively good, as almost all children were independent at follow-up. However, only a quarter of the surviving children had no physical or cognitive deficit after a mean follow-up period of 10 years. The majority had low self-esteem as well as emotional, behavioural, and health problems.

Spontaneous Intracranial Hemorrhage in Children

“…This is consistent with other series of SICH in childhood [14, 17, 19, 21]. In various studies dealing with cerebral AVM, hemorrhage was found to be most frequent clinical manifestation, occurring in 55–75% of patients in all age groups [18,19,20,21,22].…”

“…Hematological abnormalities are reported to be the major risk factor in 10–30% of SICH in most series [8, 14]. Hematological causes of IPH include thrombocytopenia, hemophilia and coagulopathies.…”

Cerebrovascular disease and stroke

“…Patients with brain tumours, bleeding diatheses, anaemia (including SCD11), leukaemia and metabolic disease are also at risk. Compared with ischaemic stroke (fig 1B–F), mortality is higher (8–40%) and recurrence is lower (in a population-based study, 13% for those with medical aetiologies, mainly acutely, and a 5-year cumulative recurrence rate of 13% for those with unoperated AVMs or tumours9), although functional outcome may be better, although only a quarter of patients have no physical or cognitive impairment 12…”

“…The underlying cause or trigger may be a diagnostic clue to the distinction between ATS, VST and stroke mimics5 18 (figs 3–5). AIS and VST are associated with death in 6–16%12 19 and 3–8% of patients,15 20 respectively, higher in those with premorbid conditions (figs 3, 4) and in the critically ill,19 while 40–60% of both groups have significant disability 17 21. Recurrence rates are age and diagnosis dependent: 3% in neonates,13 6% (3% cerebral) after VST in children 2 years of age with no evidence for recurrence after neonatal VST,20 and 10% stroke with an additional 20–35% transient ischaemic events (TIAs) after AIS in childhood 22 – 24…”

Hemiparesis and Epilepsy Are Associated With Worse Reported Health Status Following Unilateral Stroke in Children

“…1–4 Most outcome studies have focused on deficits determined by a neurologist or other health care professional. However, to understand the lasting impact of stroke on the day-to-day life of survivors, measures of health status are most informative.…”